Sovaldi plus Ribivarin

[diamondd]

Between 2002 and 2004, I did two rounds of the interferon/ribivarin combo...one for six months and then, six months later, the twelve-month regimen. After the twelve-month regimen, my viral load was undetectable, but, 30 days later, it had jumped back to over a million.
I'm a 1b. My liver has declined to stage 4, cirrhotic, compensated status with hypertensive portal gastropathy (grade 1 esophageal varices).
Last summer, after an MRI and endoscopy, when the doctor made the stage 4 diagnosis, he said that I could wait a couple of years, when the new all-in-one combo pill is available and I'll be able to be on Medicare Part D. (I have no prescription coverage now.)
I had another visit at the end of March where he performed a cursory physical exam. I'd had a routine blood test which only showed a slight elevation of one liver enzyme and slightly elevated hematocrit.
I was totally shocked when he said that I had to start treatment NOW. Ultimately, what he is recommending is Sovaldi and Ribivarin (no interferon).
I can find no clinical studies using this combo, except for those coinfected with HIV (and those folks were already on other antivirals, so it doesn't seem to apply).
Does anyone know of a study on this combo for a 1b, and what the SVR is? Does it sound like a good idea? The drug company already called and is checking to see if there are funds in its charitable program for the course of treatment. My income is just a tad too high for any other public assistance.
I'm also wondering about Off-label Sovaldi and Olysio (as long as I'm dreaming). Thanks for reading this. I've trolled here for years, but finally put my big-girl panties on and decided I needed to find some answers.

[Mike]

Hi Diamond,

SOL+RIBV is the recommended treatment for genotype 1a and 1b when interferon is not tolerated. This would be a 24 week course with 80+% SVR, though liver function and other factors can impact success rates.

Another combination would be SOL+RIBV+SMV (simeprevir) x 12 weeks.

Best wishes, Mike

[diamondd]

Thank you so much for your response.
I'm curious as to where you found that data. I've looked everywhere to no avail.
Thanks again.

[Mike]

Generally speaking, most Hep-C genotype-specific treatment efficacy studies report genotype "1" as a group (i.e, 1a and 1b).

This means that, if the research reports a 90% overall tx success rate for genotype 1, it applies to both 1a & 1b, as statistically the predicted outcome is the same for each subgroup.

Best wishes, Mike

[Mike]

Here's a current genotype-specific treatment research study that will probably answer most of your questions, Mike


http://hcvguidelines.org/full-report/initial-treatment-hcv-infection-patients-starting-treatment

[diamondd]

Yes, that is great info. Thanks, Mike. Just got back from visit with nurse practitioner at dr.'s office. Showing her test results, she recommends waiting for the Gilead combo pill, which she expects at end of 2014. I'm still thinking it over, but the combo pill seems like the gold standard...and it's approval is only months away. Additionally, she noted that the dr. had added peg-interferon to the current protocol he's recommending. Having gone through that twice, I don't think I want to go through that again.